Introduction: The lifetime-risk of developing a prolapse adds up to around 24%, the risk of undergoing surgery because of it to around 19%. Pelvic organ prolapse is an issue and, considering demographic change, will be in the future. Vaginal native tissue repair is cost- and time-effective. Even though it is still one of the standard operating techniques there are not many prospective studies about it with a longer follow up. Particularly regarding the recent banishment of mesh products in Great Britain, Australia and New Zealand we must revisit the vaginal native tissue approach as surgical treatment for POP.

Objective: The objective of this study is to provide prospective data on the outcome and patient satisfaction of vaginal native tissue repair with vaginal hysterectomy, sacrouterine or sacrospinous fixation and anterior/posterior midline plications 5 years after surgery.

Methods: Prospective Study of currently n=84 patients who underwent surgery 5 years ago. The perioperative data and the findings at the routine 3-months follow-up were combined into a database. All patients had been contacted and were invited for a 5 year follow up. Patients were asked to complete the ICIQ-FLUTS questionnaire preoperatively and 3 months and 5 years postoperatively. At the 5 years follow-up they also completed the ICIQ UI SF. We applied the POP-Q system to quantify the prolapse.

Results: When asked how satisfied they were with the surgery at the moment 63% (n=53) chose „very much better“, 23% (n=19) „better“, 7% (n=6) „a little better“, 5% (n=4) „unchanged“ and only 2% (n=2) „worse or very much worse“. A recurrent prolapse POP-Q stage II or higher was diagnosed in 44% (n=37) of cases. The predominant location was the anterior department with 40% (n=34). In 4 % (n=3) the vaginal cuff and in 5% (n=4) the posterior department prolapsed. Only 7% (n=5) reported a bulging sensation.

Table 1 – Change in POP-Q in the anterior compartment

POP-Q

preoperatively

n (%)

postoperatively

n (%)

n=84

n=84

0

3 (4)

17 (20)

I

7 (9)

33 (39)

II

30 (36)

34 (40)

III

40 (48)

-

IV

4 (5)

-

On ultrasound examination 47% (n=39) of women were diagnosed with a cystocele. 6% with a recto-/enterocele. The risk of a recurrent operation because of prolapse or incontinence was 14% (n=12), 11% (n=11) had been operated on for stress urinary incontinence and only 3% (n=4) because of recurrent prolapse. 44% (n=37) reported symptoms of stress urinary incontinence, 18% (n=15) were de novo cases. Overactive Bladder symptoms where noted in 42% (n=35), 31% (n=26) with incontinence. A de novo OAB was found in 19% (n=16) after five years.

Conclusion: The vaginal native tissue repair for severe pelvic organ prolapse provides a good long-term fixation of the vaginal cuff and the posterior department. Even though there is a 40% recurrence rate in the anterior department, the procedure still provides a improvement as shown in Table 1 and the patient satisfaction rate is very high. The risk of a recurrent operation because of prolapse was very low in the series. However, there is a 18% chance of developing a de novo SUI and 11% had to be treated surgically for it.